Cervical Discogenic Pain Syndrome

Original Editor - Rishab Mishra Top Contributors - Rishab Mishra and Uchechukwu Chukwuemeka

Introduction

Chronic neck pain is a major public health concern, accounting for one of the top five chronic pain syndromes. The pain can originate in cervical intervertebral discs, facet joints, or atlantoaxial joints. Cervical discogenic pain syndrome (CDPS) is a prevalent cause of neck discomfort, with reported rates ranging from 16% to 41%. Cervical discs contain a large number of nerve fibres that are vulnerable to structural instability and inflammatory reactions, making them prone to pain. Initially, the symptoms are proximal, although they can advance to brachialgia. Conservative therapy can alleviate the pain, but persistent pain may necessitate more intervention. C5/C6 and C6/C7 are the most typically impacted levels, with C7 being the most frequently implicated nerve root. This video gives a visual explanation of CDPS

Epidemiology

Cervical discogenic pain syndrome is a prevalent cause of neck pain, with reported prevalence ranging from 16% to 41%. In terms of spinal intervertebral disc disease, cervical intervertebral disc disease comes in second only to lumbar disc disease. It accounts for one-fifth of all orthopaedic practice visits. Neck pain ranks among the most common five chronic pain conditions in terms of disability years and prevalence. Cervical discogenic pain syndrome affects both men and women, but it is more common in women. Its prevalence rises with ageing.

Etiology

Cervical discogenic pain

Cervical discogenic pain syndrome may be caused by intervertebral disc degeneration. These alterations are typically caused by mechanical forces. Predisposing factors include extended neck flexion or protruding head posture, frequent flexion, quick abrupt movements, and trauma. Sports-related spine injuries could potentially put people at risk for CDPS.

Differential Diagnosis

Differential diagnoses may include:

• Cervical disc injuries,
• Cervical facet syndrome,
• Cervical myofascial pain,
• Cervical spine sprain/strain injuries,
• Atlantoaxial joint pain,
• Fibromyalgia, or spondylosis.

Cervical discogenic pain syndrome is initially treated conservatively, so it is important to rule out the following clinical parameters promptly:

• Cancer: more importantly, for persons aged over 50, a cancer history, and weight loss of unknown cause.
• Infection: This could be suspected if there was a history of recent surgery, drug use, and fever/chills.
• Trauma (motor vehicle accident, work-related injury, sports-related injury, previous neck surgery)
• Neurological deficits: This could be suspected if there is a weakness, loss of reflex, bowel/bladder problems

Diagnosis procedure

The physical examination should include an evaluation for a disease presentation comparable to myelopathy. Patients should be monitored and checked for neurological abnormalities such as impaired balance, motor/sensory deficits in all extremities, and upper/lower motor neuron findings. Strength and reflexes might remain unaltered; however, these results may differ depending on the source and severity of the disorder. Patients may have diminished sensation along a certain dermatome. They may have incorrect posture and a reduced range of movement.

These provocative tests may be used during the spine examination:

• A positive spurling test along with repeatable discomfort may indicate cervical radiculopathy.
• A positive Lhermitte test causes an electric shock-like sensation along the spine and/or arm, which may indicate cervical spondylosis or myelopathy.
• Shoulder abduction relief sign known as the Bakody Sign can be produced by requesting that the patient voluntarily abduct their shoulder and place their hand on top of their head. A positive test is the reduction (or decrease) of radicular pain caused by this manoeuvre, which may indicate cervical radiculopathy.
• The arm squeeze test involves squeezing the middle one-third of the upper arm. If discomfort is felt, it may indicate that the source of the shoulder pain is cervical as opposed to a shoulder pathology.

Management and reaction

Cervical discogenic pain syndrome can be managed in a variety of ways, depending on the cause, severity, and clinical presentation. The first course of action is always dedicated nonsurgical treatment, which includes the use of NSAIDs, partial rest, proper posture and body mechanics, as well as home-based exercise programs. Instantaneous recovery is frequently common within the initial few weeks of treatment. Physical therapy typically focuses on maintaining exercises, manipulation, proper posture and body ergonomics. The McKenzie technique was used to create a particular rehabilitation exercise program based on initial ROM and repeated motions of the cervical spine. Patients with cervical discogenic pain syndrome might need cervical epidural injections or nerve root blocks to help them participate in physical therapy. These therapies are best used in conjunction with therapy and are rarely successful on their own. These videos show rehabilitation and exercise techniques used to manage CDPS.

Cervical vertebrae

Patients who do not react to suitable conservative treatments and have persistent radicular discomfort, worsening neurologic impairments, motor weakness, or symptoms of cord compression might opt for surgery. Patients with discogenic neck pain might gain from anterior cervical discectomy and fusion surgery. To improve surgical results, a preoperative cervical provocative discography is required to define surgical levels. This intervention has been found to be helpful in relieving pain and improving functional outcomes.